the 6mo diet, way around it?

[bobdole 0]

My girlfriend is trying to get lap-band surgery. My insurance company, PHCS is requiring "the dread-ed 6 month diet". I am wondering if there is anyway out of this? She is ~250lbs, 5'8", and BMI ~39. She has other medical issues that is causing problems with this is the main problem. She has severe Fibromyalgia to the point that she is sometimes to tired or hurting to bad to get up and go to the bathroom and just holds it. She is pretty much bedridden now due to both pain and fatigue. Because of the fatigue and pain it is absolute hell for her to get up to go to doctors appointments and that is generally the only thing she leaves the house for. She misses those appointments often as well due to this. She has other comorbid issues to go with her 39BMI. Moderate sleep apnea, arthitus in her feet, body pain, and is teetering on diabetes.

From what I understand of this 6mo diet, you have to see a nutritionist once a month every month and a physciain every 3 months. I and she are pretty skeptical that she can make these appointments regularly and would atleast miss one or two at which point the 6mo supervised diet is basically restarted ending up with her never getting this surgery.

I and she believe that if she were to lose weight she would gain back much of the energy that she has lost over the past 4 years since she began symptoms of fibro, alleviate some of the pain, as well as her self esteem which has suffered terribly.

I am trying to search for any cases where an insurance company requires a 6 month medically supervised diet and someone was able to bypass it and any details about such cases. If anyone knows of anything like this or has any advice please reply.

[gordonfamily3 0]

I work for a local surgeon in NC and from my exp we have NEVER gotten around the 6 month diet. I am sorry to not share better news but the insurnace companies are actually easy to work w/ IF you follow their guidelines. Now you could contact someone like Obesitylaw.com and see if they have any better ideas. I hate to here she is having such trouble. I wish her the best of luck!

[bobdole 0]

Hmm defintely not good news. If we absolutely have to, we may try and self pay. She has been fighting to get on government disability for over a year and has been denied 3 times. We got a lawyer involved now who says this will be no problem and he can push it through (just a side note, our nations disability application process is pretty f'd up). Anyways, she'll likely be getting that + backpay from the point she first applied which could perhaps cover the surgery costs.

We would love to make use of my insurance though, so if anyone else has any useful info please let me know.